2. Lesson Objectives
Describe the incidence, survival, and mortality rates of
cancer across the globe.
Describe the processes involved in the biology of cancer.
Outline the stages of cancer development.
Discuss the role of the nurse in the prevention,
detection, and diagnosis of cancer.
Explain the use of surgery, chemotherapy, radiation
therapy in the treatment of cancer.
8. Cancer is defined as:
A group of diseases characterized by uncontrolled
and unregulated growth of cells, invade, erode
and destroy near by cells.
Cancer is often considered a disease of aging, with
most cases diagnosed in those over age 55 years.
However, it occurs in people of all ages.
9. Cancer is defined as:
People often think of the word cancer as describing single disease
with a single cause.
There are over 200 cancers that can occur anywhere in the body.
12. Cancer (incidence, prevalence and
An estimated 1.7 million people in the United States are
diagnosed annually with invasive cancer.
More men than women die from cancer-related deaths
It is the second most common cause of death in the
It is the leading cause of death of people 40 to 79 years
Each year about 609,640 Americans are expected to die
because of cancer, which is more than 1600 people per
13. Cancer (incidence, prevalence and
Is preventable (most types)
80 – 90% are due to our habits and activities
70 – 80 % cases are detected at late stage
when treatment is not possible
15. Origins of Cancer cells
Carcinomas: constitute 90% of cancers, are cancers of
Sarcomas: are rare and consist of tumors of connective
tissues (connective tissue, muscle, bone etc.)
Leukemia and lymphomas: constitutes 8% of tumors.
Sometimes referred to as liquid tumors.
Leukemia arises from blood forming cells and lymphomas
arise from cells of the immune system (T and B cells).
16. Biology of cancer
Two major dysfunctions present in the process
of cancer development are:
Defective cell proliferation (growth)
Defective cell differentiation (maturation)
17. Biology of Cancer (Defective cell
Cell proliferation (from the time of cell birth to the time of
cell death) starts in the stem cell.
The time from when a cell enters the cell cycle to when the
cell divides into 2 identical cells is called the generation time
of the cell.
A mature cell continues to function until it degenerates and
All the body’s cells are controlled by an intracellular
mechanism that determines when cell proliferation is
Under normal conditions proliferation equals cell
degeneration or death (apoptosis).
18. Biology of Cancer (Defective cell
However, cancer cells respond differently from normal
cells to the intracellular signals that regulate cell
proliferation and death.
The result is that the proliferation of the cancer cells is
indiscriminate and continuous.
Sometimes they produce more than 2 cells at the time
In this way, there is continuous growth of a tumor
mass:1 × 2 × 4 × 8… This is termed the pyramid effect.
The time needed for a tumor mass to double in size is
known as its doubling time.
19. Biology of Cancer (Defect in Cell
Cell differentiation is normally an orderly process that
progresses from a state of immaturity to a state of maturity.
Because all body cells are derived from the fertilized ova, all
cells have the potential to perform all body functions.
As cells differentiate, this potential is repressed, and the
mature cell can perform only specific functions.
With cell differentiation, there is a stable and orderly phasing
out of cell potential.
Under normal conditions, the differentiated cell is stable and
will not dedifferentiate, or return to its previous
If this process is disturbed cancer cells will start to develop.
20. Development of Cancer (phases)
Involves a mutation in the cell’s genetic structure.
Carcinogens (substances that can cause cancer),
such as chemicals, physical factors, or biologic
agents, cause mutations in the cellular DNA.
Normally, these alterations are reversed by DNA
repair mechanisms or the changes initiate
programmed cellular death (apoptosis) or cell
21. Development of Cancer (phases)
Is characterized by the reversible proliferation of the
An increase in the altered cell population further
increases the likelihood of more mutations.
An important distinction between initiation and
promotion is that the activity of promoters is
This is a key concept in cancer prevention.
Promoting factors include agents such as dietary
fat, obesity, cigarette smoking, and alcohol use.
22. Development of Cancer (phases)
Progression is the last stage in the natural history of a
This stage is characterized by increased growth rate of the
tumor, increased invasiveness, and metastasis (spread
of the cancer to a distant site).
Certain cancers have an affinity for a particular tissue or
organ as a site of metastasis (e.g., colon cancer often
spreads to the liver).
Other cancers (e.g., melanoma) are unpredictable in their
pattern of metastasis.
The most common sites of metastasis are lungs, liver,
bone, brain (including CSF), and adrenal glands.
23. Development of Cancer (phases)
Metastasis is a multistep process.
It begins with the rapid growth of the primary tumor.
As the tumor increases in size, developing its own blood
supply is critical to its survival and growth.
The process of the formation of blood vessels within the
tumor itself is termed tumor angiogenesis.
It is facilitated by tumor angiogenesis factors made by
the cancer cells.
Metastasis occurs either through Hematogenous or
27. Histologic Classification (Grading)
Grade I: Cells differ slightly from normal cells (mild
dysplasia) and are well differentiated (low grade).
Grade II: Cells are more abnormal (moderate dysplasia)
and moderately differentiated (intermediate grade).
Grade III: Cells are very abnormal (severe dysplasia)
and poorly differentiated (high grade).
Grade IV: Cells are immature, primitive (anaplasia), and
undifferentiated; cell of origin is hard to determine (high
Grade X: Grade cannot be assessed.
28. Extent of Disease Classification
Determines the anatomic extent of the malignant disease
process by stages:
Stage 0: indicates that the cancer is where it started (in situ)
and hasn't spread
Stage I: the cancer is small and hasn't spread anywhere else
Stage II: the cancer has grown, but hasn't spread
Stage III: the cancer is larger and may have spread to the
surrounding tissues and/or the lymph nodes.
Stage IV: the cancer has spread from where it started to at
least one other body organ; also known as "secondary" or
30. TNM Classification System
The TNM classification system is used to determine
the anatomic extent of the disease involvement
according to 3 parameters:
Tumor size and invasiveness (T),
Presence or absence of regional spread to the
lymph nodes (N),
Metastasis to distant organ sites (M)
TNM staging cannot be applied to all cancers.
For example, leukemia are not solid tumors and
cannot be staged.
32. Staging vs TNM classifications
Stage 0 Indicates carcinoma in situ = Tis, N0, M0.
Stage I Localized cancer = T1-T2, N0, M0.
Stage II Locally advanced cancer, early stages =
T2-T4, N0, M0.
Stage III Locally advanced cancer, late stages =
T1-T4, N1-N3, M0.
Stage IV Metastatic cancer = T1-T4, N1-N3, M1.
33. Possible Causes of Cancers
Virus (11% of all Ca, E.g: HBV, HPV)
Bacteria (H Pylori linked with gastric Ca)
Physical/chemical agents (sun light, radiation,
tobacco, chronic irritation, industrial chemicals like
Genetic /familial factors (5-10% of all Ca)
Life style factors (1/4-1/3 of all Ca)(diet (alcohol,
processed meats,..), obesity, physical inactivity)
Hormonal agents,...and advancing age
34. Common sign/symptoms of Cancer in both
Weight loss without trying (almost 50% of the pt)
Fatigue (even not improved during rest)
Changes on skin (moles or marks ....)
Sore that does not heal
Cough /hoarseness/ that does not go away
35. Common Signals of cancer
Blood in the stool
Blood in the urine
Cough that doesn’t go away
Fever that doesn’t go away
Lump in the neck, swollen lymph nodes
36. Diagnosis of Cancer
Ultrasounds to determine size
CT scan with contrast (the golden standard)
Genetic markers (like BRCA 1, BRCA 2,...)
CEA (carcinoembryonic antigen) general carcinogenic
PSA (prostate specific antigen)
Liver function test, renal function test, ....etc
38. Goals of cancer therapy
Refers to prolonged absence of detectable
When cure is unrealistic
Prevent new cancer growth
When cure or control is impossible
Reduce side effects/symptoms of disease
40. Treatment Modalities of Cancer
Is often the first line of choice for solid tumors, whenever
Surgery may/may not be combined with other modalities.
The size, type, location of tumor and factors such as age,
comorbid conditions of a patient are key determinant
factors in choosing surgery.
In some cases where the primary tumor has not
metastasized surgery may be considered as curative
41. Treatment Modalities of Cancer
Types of surgery
Involves local and wide /radical/ excision
Reconstructive surgery (follows curative,
42. Treatment Modalities of Cancer
2. Radiation therapy
High energy waves such as x-rays, gamma rays or electron
beams may be used to destroy or shrink tumor cells.
May be offered prior to or following surgery or
chemotherapy. Can affect healthy cells.
It can also be used for palliation to relieve symptoms of
pain caused by tumor lesions that are inoperable.
The outcome of radiation therapy is dependent on several
factors such as dose, duration, mode of radiation delivered
and the properties of the tumor such as its molecular
properties, sensitivity to radiation, oxygenation, etc.
43. Treatment Modalities of Cancer
Two types of ionizing radiation electromagnetic radiation
(x-rays and gamma rays) and particulate radiation
(electrons, beta particles, protons, neutrons, and alpha
particles) can be used to kill cells.
The most lethal damage is the direct alteration of the
DNA molecule within the cells of both malignant
Radiation can be administered externally (teletherapy)
(common one) or internally (brachytherapy)
45. Treatment Modalities of Cancer
Are drugs that destroy or kill cancerous cells.
Administered through different routes depending on
individual cancer cases.
Can be given in combination with surgery and
Can affect healthy normal cells.
The side effects may vary depending on the type of
drug, dose, duration and the nature of cancer, age
of the patient, etc.
47. Treatment Modalities of Cancer
4. Targeted Therapy (precision medicine)
These molecules are specifically tailored to target tumor cells.
This may be used in conjunction with other cancer treatment modalities.
It is important to note that, not every patient is a candidate for targeted
therapy. Cancers with tumors that express certain targets for this class of
drugs can only be treated using this therapy.
Targeted therapy may work in one of the following ways:
Trigger a patient’s own immune system to destroy cancer cells
May interfere with signals or proteins that prevent tumor cells from
Hormone therapy: they may be specifically used on hormones that
have receptors to hormones.
48. Treatment Modalities of Cancer
5. Palliative Care /Comfort Care/ /Support Care/
Provides continuous care to improve quality of life, ease
symptoms of cancer treatment and provide psychological,
social and spiritual support.
Begins during diagnosis and continues through treatment,
follow-up care and post-treatment management.
All aspects of the patient will be comforted as needed.
49. Treatment Modalities of Cancer
6. Nuclear Medicine
It’s rationale is to provide diagnosis using
radioactive isotopes of molecules.
In cancers such as those affecting the thyroid
gland I-131 therapy (radioactive iodine) is used.
50. Treatment Modalities of Cancer
7. Intervention Radiology
Uses minimally-invasive procedures
Used in diagnosis as well as of cancer management.
Image-guided, minimally invasive procedures such as radiofrequency
ablation, chemoembolization, trans-arterial catheterization (TAC), etc
are carried out with the help of MRI, CT, ultrasonography, fluoroscopy,
The procedures of intervention radiology have provided new hope to
many patients who have unresectable tumors too.
It has helped in reduced hospital time, minimizing the risk of post-
operation procedures and has improved the accuracy of cancer care.
51. Cancer Treatment Response
Complete response (complete remission) is the
disappearance of all detectable malignant disease.
Partial response: is decrease by more than 50% in
the sum of the products of the perpendicular diameters
of all measurable lesions.
Stable disease: no increase in size of any lesion nor
the appearance of any new lesions.
Progressive disease: means an increase by at least
25% in the sum of the products of the perpendicular
diameters of measurable lesion or the appearance of
53. Primary prevention
Reduce the risks of disease through health
promotion and risk reduction strategies
Immunization (HBV.....Cervical Ca)
Weight reduction for obese/ maintain ideal body
Regular physical exercise /avoid sedentary lives/
Choose whole grains, fruits, vegs,
Avoid/minimize alcohols, processed/red meats...
Provide safe and enjoyable environments
54. Secondary prevention
Involves screening and early detection activities
that seek to identify precancerous lesions and
early-stage cancer in individuals who lack signs
and symptoms of cancer.
Early detection reduces costs and morbidity
Mammography for breast
Pat test and HPV DNA test for cervix
55. Secondary prevention
Why early detection is important ?
Disease detected at early stage produces
better results on treatment and even cure
Advanced disease shows poor result on
Advanced disease leads to financial and
56. Tertiary prevention
Focus on monitoring for and preventing
recurrence of the primary cancer as well as
screening for the development of second
malignancies in cancer survivors.
Survivors may also develop second malignancies
not related to treatment but genetic mutations
related to inherited cancer syndromes,
environmental exposures, and lifestyle factors.